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I notice there's a case in Chicago. I know a lot of Asians. I wonder how many degrees of separation I am from the victim.

Since the Ministry of Health (MOH) press release yesterday, 2 more patients have been diagnosed with SARS. The new cases are both close contacts of the cases. In total, 23 cases of SARS have been reported. Other than the initial 3 cases, the additional 20 patients are all close contacts of patients with SARS, 8 of them being hospital staff. All the patients are stable, except for 4 patients who are in a serious condition.

The Ministry of Health would like to appeal to the public to avoid travel to Hong Kong, Hanoi, and Guangdong province in China for the time being, unless absolutely necessary. This would help us greatly in our efforts to contain the number of new cases. We hope that we will continue to see a decreasing number of cases of SARS as we have put in place the necessary precautionary measures.

We also advise you to stay calm and continue with your daily routine. Though SARS is infectious, there is no need for alarm as your risk of SARS is low.
The World Health Organization (WHO) has reported that the disease is spread from person to person but only through close contact with an infected person. There is no evidence to date that the disease spreads through casual contact. Apart from the initial 3 cases, those who came down with SARS in Singapore were family members and friends, and hospital staff who had come into close contacts with the infected patients.

The Ministry would like to reiterate that you should seek immediate medical attention if you have:

- fever (greater than 38 degrees Celsius) and respiratory symptoms including cough, shortness of breath, or breathing difficulty; AND

- have travelled to Hong Kong, Hanoi, or Guangdong province in China, within 2 weeks of onset of the symptoms; or

- are a close contact of a person(s) diagnosed with SARS. (Close contact means having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with SARS)

Since the Ministry of Health (MOH) press release yesterday, 2 more patients have been diagnosed with SARS. The new cases are both close contacts of the cases. In total, 23 cases of SARS have been reported. Other than the initial 3 cases, the additional 20 patients are all close contacts of patients with SARS, 8 of them being hospital staff. All the patients are stable, except for 4 patients who are in a serious condition.

The Ministry of Health would like to appeal to the public to avoid travel to Hong Kong, Hanoi, and Guangdong province in China for the time being, unless absolutely necessary. This would help us greatly in our efforts to contain the number of new cases. We hope that we will continue to see a decreasing number of cases of SARS as we have put in place the necessary precautionary measures.
We also advise you to stay calm and continue with your daily routine. Though SARS is infectious, there is no need for alarm as your risk of SARS is low. The World Health Organization (WHO) has reported that the
The following is jointly issued by the Department of Health and the Hospital Authority: As at 1pm today (18 Mar 2003), the admission statistics of patients who have been in close contacts with atypical pneumonia patients are as follows:

A. Staff of Hospitals/Clinics

(numbers in brackets are those with symptoms of pneumonia) Staff of Prince of Wales Hospital (PWH) admitted to: Prince of Wales Hospital 44 (36)

Kwong Wah Hospital 1 (1)
Princess Margaret Hospital (PMH) 1 (1)

Tseung Kwan O Hospital 1 (1)

Staff of Kwong Wah Hospital (KWH) admitted to: Kwong Wah Hospital 2 (2)

Staff of Pamela Youde Nethersole Eastern Hospital (PYNEH) admitted to: Pamela Youde Nethersole Eastern Hospital 7 (7)

Staff of Queen Elizabeth Hospital admitted to: Queen Elizabeth Hospital 4 (1)

Staff of a Private Clinic in Mong Kok admitted to: Princess Margaret Hospital 3 (3) Tuen Mun Hospital 1 (0)

Staff of a private hospital on HK Island admitted to: Pamela Youde Nethersole Eastern Hospital 3 (3)
Sub-total (A) 67 (55)

B. Medical Students (numbers in brackets are those with symptoms of pneumonia) Medical students Prince of Wales Hospital 17 (17)

C. Other Close contacts of Index Patient (numbers in brackets are those with symptoms of pneumonia) Family members & visitors PWH, PMH, KWH, PYNEH & Queen Mary Hospital 39 (39)

Total admissions
(A + B + C) 123 (111)

It is possible for the status of a reported case to change over time. SARS is a diagnosis of exclusion. This means that whenever a known cause is found that could fully account for a patient's clinical condition, this patient should no longer be considered to be a case of SARS.

Two cases attributed to Switzerland on 17 Mar 2003 no longer fulfilled the case definition of SARS after further clinical assessment.
+ The Chinese authorities have reported suspect and probable cases in Guangdong province. Figures are being updated.
* No documented secondary transmission in-country. No affected areas.
**The death attributed to Hong Kong SAR of China occurred in a case medically transferred from Viet Nam.

At present, the vast majority of cases are concentrated in Hong Kong Special Administrative Region of China and Hanoi, Viet Nam.

Singapore is currently reporting the third largest number of cases. All reported cases in other parts of the world are linked to travel within the past 10 days to one of these destinations. It remains undetermined whether an outbreak of atypical pneumonia in southern China, which began in November, is related to the current outbreaks.
In Hanoi, 13 of the 57 patients are showing signs of clinical improvement.

Awareness of the disease is now very high throughout the world. Surveillance is proving to be sensitive, with suspected cases rapidly detected, reported to national authorities and WHO, and investigated according to the standard case definition. An increase in the number of suspected cases is to be expected in such an atmosphere of heightened awareness.

In areas where person to person transmission has been documented, cases have occurred almost exclusively in health care workers or in people in very close contact with patients, such as family members. Currently available data indicate that transmission of the infectious agent requires direct and close contact. There is no evidence of transmission following casual contact.

Due to heightened awareness, cases are now being quickly identified and immediately isolated. No cases of secondary transmission are occurring following the detection and proper management of imported cases.

Protective measures and strict barrier nursing procedures are now in place in hospitals in all areas where cases have been reported. In areas where person to person transmission has occurred, these measures are expected to decrease transmission to health staff and families of patients. Strict protective measures in countries managing imported cases are likewise expected to reduce the risk that the disease will spread to others within these countries.

Efforts are under way to expedite identification of the causative agent, improve diagnostic precision, and develop a diagnostic test. A network of 11 highly qualified laboratories in 10 countries was established yesterday and has begun data sharing and regular reporting today.

Many countries have activated well designed national preparedness plans for dealing with an emerging infectious disease. The global surveillance system, which WHO coordinates, is working well in the ways needed to prevent the outbreak from becoming a global epidemic.

HONG KONG (AP): A pneumonia patient believed to have spread a mysterious respiratory illness to dozens of hospital workers in Hong Kong traveled to mainland China before he became ill. Dr Leung Ping-chung, who has been working throughout the pneumonia outbreak at Hong Kong's hardest-hit hospital, told the Associated Press the patient believed to have spread the illness was a man aged in his 40s who had visited Hainan island and other parts of southern China. Leung said the patient, who has not been identified by name, is "still very sick" in the hospital.

Health authorities are trying to determine whether disease outbreaks in Hong Kong, Vietnam and elsewhere are linked to an illness in mainland China's southern Guangdong province that recently sickened 305 people and killed 5.

On Monday, Hong Kong's health chief, Dr Yeoh Eng-kiong, said that officials had identified the "index patient" who apparently has spread the disease to 68 people, mainly medical workers, at the Prince of Wales Hospital, but declined to provide any details about the patient.

There was a death of a Hong Kong man who visited mainland [China] and fell ill, admitted to hospital on 22 Feb 2003. He died 11 days later at Kwong Wah hospital on 4 Mar 2003. He had atypical pneumonia symptoms and his sister was also taken ill too, although little information is available. Later, we have the "official" HK outbreak reported at Kwong Wah Hospital, HK.

To put you in the picture a little, the Hong Kong/China border is busy, comprising 5 crossing points and built and staffed to handle more than 200 000 people a day plus countless container lorries.

Every day, thousands (I don't have a precise figure must be near 5000) cross the border, many people would consider a day trip to China as normal activity:

- border is open 24 hrs a day.

- thousands of people live in China and cross for work in Hong Kong.

- hundreds more cross the border twice a day, whether it is Chinese kids coming here for schooling in Hong Kong, or businessman going over for dinner and entertainment, or day shoppers or traders; the border creates great opportunities for trade and 2 way infection everyday.

As of today, health authorities are investigating reported cases in Canada, China, Taiwan (China), Germany, Hong Kong SAR of China, Singapore, Slovenia, Thailand, Viet Nam, and the United Kingdom." Newswire reports also mention suspected cases in the USA, Sweden, and Austria. Additional countries are likely to be added to the list as the heightened alert brings cases to the attention of the authorities. In this era of rapid transport and extensive travel, we live in a global village and should not be surprised to have cases among travellers who may have had close contact with SARS cases in countries where transmission has been identified.

In [4] above, it is interesting that there was travel to southern China preceded the onset of illness. [5] also mentions an early case with a history of travel to southern China, and an interesting description of the communications between southern China and Hong Kong SAR of China. We await more information on the outbreak of a SARS-like illness in Guangdong China when it becomes available.

On the positive note, it does not appear that casual contact with cases is a significant mode of transmission as the overwhelming majority of cases continue to be in people with known close contact with other cases. Also it appears that barrier nursing precautions